Multi-institutional external validation of seminal vesicle invasion nomograms: head-to-head comparison of Gallina nomogram versus 2007 Partin tables.
OBJECTIVE
The Partin tables represent one of the most widely used prostate cancer staging tools for seminal vesicle invasion (SVI) prediction. Recently, Gallina et al. reported a novel staging tool for the prediction of SVI that further incorporated the use of the percentage of positive biopsy cores. We performed an external validation of the Gallina et al. nomogram and the 2007 Partin tables in a large, multi-institutional North American cohort of men treated with robotic-assisted radical prostatectomy.


METHODS
Clinical and pathologic data were prospectively gathered from 2,606 patients treated with robotic-assisted radical prostatectomy at one of four North American robotic referral centers between 2002 and 2007. Discrimination was quantified with the area under the receiver operating characteristics curve. The calibration compared the predicted and observed SVI rates throughout the entire range of predictions.


RESULTS
At robotic-assisted radical prostatectomy, SVI was recorded in 4.2% of patients. The discriminant properties of the Gallina et al. nomogram resulted in 81% accuracy compared with 78% for the 2007 Partin tables. The Gallina et al. nomogram overestimated the true rate of SVI. Conversely, the Partin tables underestimated the true rate of SVI.


CONCLUSIONS
The Gallina et al. nomogram offers greater accuracy (81%) than the 2007 Partin tables (78%). However, both tools are associated with calibration limitations that need to be acknowledged and considered before their implementation into clinical practice.
Zorn
Kevin C
KC
Section of Urology, University of Chicago Medical Center, Chicago, IL, USA.
Capitanio
Umberto
U
Jeldres
Claudio
C
Arjane
Philippe
P
Perrotte
Paul
P
Shariat
Shahrokh F
SF
Lee
David I
DI
Shalhav
Arieh L
AL
Zagaja
Gregory P
GP
Shikanov
Sergey A
SA
Gofrit
Ofer N
ON
Thong
Alan E
AE
Albala
David M
DM
Sun
Leon
L
Karakiewicz
Pierre I
PI
D019540:Area Under Curve; D002138:Calibration; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000379:methods*; D049451:Nomograms; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012372:ROC Curve; D012371:Robotics; D012669:Seminal Vesicles / Q000473:pathology*